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Treating Panic Disorder and OCD with Exposure and Response Prevention (ERP)

Treating Panic Disorder and OCD with Exposure and Response Prevention (ERP)

There are many different approaches to treating and managing panic disorder and obsessive compulsive disorder (OCD).

While these two conditions are not the same, there are some similarities in commonly prescribed treatments. One such method that therapists can utilize for both conditions is exposure therapy and response prevention (ERP).

Exposure therapy may sound like an oxymoron. After all, how can exposing yourself to the things you fear most actually be an effective therapeutic treatment for a mental health condition? While it may sound contradictory, this method is actually quite sound.

Here’s how using exposure therapy under the guidance of a qualified therapist can help people with panic disorder and OCD.

The Basis of Exposure Therapy with Response Prevention

So, what is the basic principle behind exposure therapy? In general, people with OCD or panic disorder do their best to avoid the situations that trigger their fears. This is a completely rational response to fear. And in the short term, it is the easiest way to protect yourself from what you’re afraid of.

Exposure therapy, however, aims to eliminate that urge to avoid certain situations. Throughout the course of treatment, you will ideally learn that the thing you were fearing doesn’t pose a real threat or danger after all. And, if you’re dealing with OCD, you also will slowly let go of your compulsive need for certain rituals before facing specific situations.  By choosing to stop the compulsions (i.e. prevent the responses), you will learn to habituate to the anxiety feelings and decrease the intensity and frequency of the obsessive thoughts.  The ERP approach allows you to break free from the vicious cycle of anxiety.

What’s Wrong With Avoidance?

We all go out of our way to avoid things that make us feel anxious or afraid sometimes. So, if we all do it occasionally, how bad can avoidance really be?

When avoidance becomes your sole strategy for dealing with a particular fear, and it begins to interfere with your everyday life and holds you back from doing what you love, another approach is necessary. Avoidance is a form of temporary relief, but it does not actually improve your overall quality of life in the long term. Eventually, it can lead to the development of other harmful behavior patterns. Over time, avoiding the fear or participating in compulsive thoughts or rituals actually increases your anxiety and may lead to extreme responses such as never leaving the house.

Getting Started

How can you begin exposure therapy sessions? It starts with the therapist working closely together with you to establish a trusting relationship and identify exactly what you fear. They will also discuss what you may view as your “worst-case scenario.”

Essentially, the goal of this collaboration is to target exactly what you’re most afraid of happening. To prepare for the treatment phase, the therapist will use everything they’ve gathered to put together a careful, step-by-step plan (also called hierarchy of fears) for gradual exposure.

How It Works

Over time, the therapist will slowly expose you to what you fear. This may include imaginal (thinking about your fears) or in-vivo (in real life).  The in-vivo exposure will take place in a completely safe environment with the support and company of the therapist. You will never have to enter a chaotic situation during treatment where you have to face your triggers with no support.  The idea is to start with less distressing fears and gradually move up to more fearful situations as you gain confidence to face your anxiety.

In these scenarios, you’re not supposed to make any efforts to avoid or minimize your exposure to the trigger. Of course, this can be very difficult. But with their therapist’s support it can get easier. And that’s exactly why they’re there.

Ultimate Goal

By the end of the treatment course, the ultimate goal of exposure therapy is to ensure that you no longer feel the need to avoid the trigger. Alternatively, if you have OCD, you will recognize that you will be safe without performing rituals and mental compulsions or responses. Through consistent exposure therapy followed by response prevention, you can begin to see that the situation you thought was so dangerous is not the threat that your mind built it up to be.

Ideally, you will slowly stop practicing avoidance in your daily life.

Exposure therapy is not a method of erasing memories of traumatic events or telling a person that their fears don’t matter. To the contrary, proving to them that they are capable of facing these triggers without being harmed is the ultimate goal.

Do you suffer from panic disorder or OCD? Are you interested in trying exposure therapy and response prevention (ERP) to see if this approach can help you in your healing journey? As a trained CBT and ERP psychologist, I can help you decide if ERP would be helpful for you. Feel free to contact me to discuss the benefits of exposure therapy and next steps.

Has Your Anxiety Become Worse Over Time? – Understanding the Reason

Has Your Anxiety Become Worse Over Time? – Understanding the Reason

Suffering from anxiety isn’t easy. No matter what anxiety you deal with, the desire for relief is always there. Whether it’s social anxiety, PTSD, OCD, agoraphobia, specific phobias, or generalized anxiety disorder, you yearn for a break from painful symptoms.

You’re probably tired of anxiety’s physical effects, such as racing heart, flushing, stomach issues, and insomnia. You’re tired of its emotional effects—running thoughts, panic, living life much less fully than you’d like.

Perhaps your anxiety has grown and become worse over time. It can feel discouraging. If you’re searching for answers and hoping for help, here is some insight into why your anxiety has become worse over time.

Lack of Treatment

Like many mental health issues, anxiety often becomes worse when it isn’t actively treated. Treatment helps you get to the root causes of your anxiety. It enables you to discover solutions and practical ways of managing its symptoms.

But when you don’t treat it, your fears and phobias can run untethered through your mind. You don’t learn to rein it in—you may not even believe that it’s possible to rein it in.

Feelings of anxiety set off the “fight, flight, or freeze” instinct in your brain. These are authentic physiological reactions with deep roots in your nervous system. This instinct wants to protect you; it readies you to respond to danger. This instinct used to be vital to survival when predators were common, and a physical threat was real. Now, though, it often overreacts to the perils of our modern world.

When you suffer from anxiety, you need to learn how to manage this fight, flight, or freeze instinct. It can be hard to do on your own. The guidance of a therapist is often necessary. If you haven’t treated your anxiety, this biological instinct can wreak havoc in your life. Learning how to calm your nervous system is possible, but the longer you’ve delayed treatment, the harder it can be.

Lack of treatment also allows one type of anxiety to mushroom into others. Perhaps you started with a phobia of flying. Over time, as you learned to avoid airplanes, your brain started thinking that car travel was also a threat. Without learning the skills to manage your first phobia, it was easier for another one to pop up.

Substance Uselotus flower

Like many health conditions, anxiety can be worsened by substance use. This includes alcohol and nicotine, along with illicit drugs. Many of these substances create feelings of anxiety. They can also lessen your body’s ability to handle your anxiety on your own.

Unrelenting Stress

Life is stressful. If you suffer from anxiety, you certainly know that. But sometimes life’s demands can be more relentless than at other times. Persistent times of stress can worsen anxiety. When you’re continually facing real-life pressures with no chance to recover, it’s harder for your body and mind to bounce back.

Job loss, natural disasters, divorce, or death of close family members, moves, and child-rearing can place heavy burdens on your shoulders. If you’re already anxiety-prone, the weight of such challenges wears your coping skills thin.

Your emotional reserves and resiliency become weaker. It’s no surprise that your anxiety has worsened over time if you’re in these situations. Seek out resources to help you become stronger and get through these challenges.

As hard as it is to believe, please know that there is hope and help for anxiety. If you’re tired of living in fear, you can find a way out. The sooner you do it, the sooner you’ll be able to find relief.

As a psychologist with over 17 years of experience in anxiety treatment, I have helped many clients move forward with renewed thinking and relief from anxiety. If you would like to read more about anxiety, click here.  Or feel free to contact me for more information regarding anxiety treatment.

High-Functioning Anxiety: The Storm Brewing Beneath a Calm Exterior

High-Functioning Anxiety: The Storm Brewing Beneath a Calm Exterior

Many people think that the symptoms of anxiety would be obvious. After all, you would assume that you could usually tell when someone is nervous, or if they’re hesitant to join in on conversations and socialize. However, anxiety isn’t always so apparent.

In fact, many people do their best to keep their anxiety symptoms under wraps. Their symptoms may not interfere with their daily life on the surface, but inside, they’re struggling. This is what’s called “high-functioning anxiety”—it’s like a storm brewing beneath a calm exterior.

People with high-functioning anxiety might seem like they are thriving in the professional and social spheres, yet no one around them recognizes their inner turmoil. Just getting through the day can still feel like a difficult balancing act. High-functioning anxiety is often a way for the mind to try to prepare for a disappointing outcome to a future problem to avoid the letdown that comes with it.

Here are a few tell-tale signs of high-functioning anxiety.

Anxiety Disguised as “Ambition”

People with high-functioning anxiety are often viewed as highly ambitious. But, sometimes, this ambition is just a cover for anxiety.

Inside, maybe you’re deeply afraid that you will lose everything you’ve worked for if you make even a minor mistake. Or you may worry that people will not love you or approve of you unless you rack up prestigious titles and accolades. Therefore, you try to prove yourself through hard work.

The Mind Never Stops

Individuals with high-functioning anxiety might feel like they can never “turn off” their thoughts. They go over the same troubling thoughts over and over again, unable to simply drop it and move on. Even when they know that they should be relaxing, they simply can’t let these thoughts go. They are prone to rumination.woman looking at computer

Perhaps, you lay awake at night imagining scenarios in which things can go wrong and how you would handle them. Or you may wake up in the middle of the night thinking about what you said or did yesterday or worrying about tomorrow. Once your mind gets going, it is impossible to fall back to sleep.

Perfectionist Mindset

If you have high-functioning anxiety, your friends might think of you as the perfectionist of the group.

On one hand, you might be proud of this: you think ahead and avoid some of the problems that your friends deal with, and you’re on top of your to-do list at all times. But you’re also constantly trying to anticipate problems and solve them before they happen. And half the time, the problems you dream up and prepare for never end up happening.

Hiding Your Feelings

Your loved ones think that you have it all together. But deep down, you know that this isn’t true.  You’re scared to express it because you worry that admitting you deal with so much anxiety will let people down. And part of having high-functioning anxiety is harboring a fear of being vulnerable. Therefore, you don’t really want to open up. You’re afraid to break the illusion. And the idea of sharing your worries makes you feel like they could come true.

Unable to Relax

If you experience high-functioning anxiety, you may find it hard to physically relax. You might carry a lot of tension in your back and shoulders. Sometimes, you may even notice that your breathing is shallow and rapid when you’re trying to focus on something. And perhaps you grind your teeth at night or experience digestive issues. While these symptoms are not severe enough to stop you from doing the things you need to do on a daily basis, they can easily make you feel uncomfortable.

Do you go through your day pretending that everything is fine—but deep down, you’re mired in anxiety and wish the people around you understood? People with high-functioning anxiety can benefit from therapy by learning strategies to quiet their minds without compromising their drive and sense of accomplishment.

To read more about anxiety, click here.  Or feel free to contact me for more information about help for anxiety.